Section of Nephrology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.
Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, UK.
Curr Opin Crit Care. 2020 Dec;26(6):581-589. doi: 10.1097/MCC.0000000000000779.
PURPOSE OF REVIEW: The aim of this study was to summarize the current evidence around the impact of individualizing patient care following an episode of acute kidney injury (AKI) in the ICU. RECENT FINDINGS: Over the last years, evidence has demonstrated that the follow-up care after episodes of AKI is lacking and standardization of this process is likely needed. Although this is informed largely by large retrospective cohort studies, a few prospective observational trials have been performed. Medication reconciliation and patient/caregiver education are important tenants of follow-up care, regardless of the severity of AKI. There is evidence the initiation and/or reinstitution of renin-angiotensin-aldosterone agents may improve patient's outcomes following AKI, although they may increase the risk for adverse events, especially when reinitiated early. In addition, 3 months after an episode of AKI, serum creatinine and proteinuria evaluation may help identify patients who are likely to develop progressive chronic kidney disease over the ensuing 5 years. Lastly, there are emerging differences between those who do and do not require renal replacement therapy (RRT) for their AKI, which may require more frequent and intense follow-up in those needing RRT. SUMMARY: Although large scale evidence-based guidelines are lacking, standardization of post-ICU-AKI is needed.
目的综述:本研究旨在总结目前关于 ICU 急性肾损伤(AKI)后个体化患者护理对患者的影响的证据。
最近发现:在过去几年中,证据表明 AKI 后的随访护理不足,可能需要对该过程进行标准化。尽管这主要是基于大型回顾性队列研究,但也进行了一些前瞻性观察性试验。药物重整和患者/照护者教育是随访护理的重要内容,无论 AKI 的严重程度如何。有证据表明,肾素-血管紧张素-醛固酮系统药物的启动和/或再使用可能改善 AKI 患者的预后,尽管它们可能增加不良事件的风险,尤其是在早期重新使用时。此外,在 AKI 发生后 3 个月,血清肌酐和蛋白尿评估可能有助于识别在接下来的 5 年内可能进展为慢性肾脏病的患者。最后,需要肾脏替代治疗(RRT)和不需要 RRT 的 AKI 患者之间存在差异,这可能需要对需要 RRT 的患者进行更频繁和更强化的随访。
总结:尽管缺乏大规模的循证指南,但需要对 ICU 后 AKI 进行标准化处理。
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